Healthcare Provider Details

I. General information

NPI: 1013002989
Provider Name (Legal Business Name): PHIL J SNYDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DEBARTOLO PLACE SUITE 1610
BOARDMAN OH
44512
US

IV. Provider business mailing address

250 DEBARTOLO PLACE SUITE 1610
BOARDMAN OH
44512
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-0000
  • Fax: 330-965-0511
Mailing address:
  • Phone: 330-965-0000
  • Fax: 330-965-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19876
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: